tbuckley/cabot-search huggingface dataset:
Prediction of daily pain and opioid consumption in hospitalized patients with cancer: The importance of psychological symptoms, previous pain, and opioid use.
Authors: Desiree Rachel Azizoddin, Jenna Wilson, Kelsey Mikayla Flowers, Meghan R Beck, Peter Chai, Andrea Catherine Enzinger, Robert R. Edwards, Christine Miaskowski, James A. Tulsky, Kristin L. Schreiber
Journal: Journal of Clinical Oncology (2022)

195 Background: Pain is among the most common reasons that cancer patients present to the emergency department (ED) and are ultimately hospitalized, yet little is known about the patient-level predictors and outcomes of pain-related ED visits and hospitalizations. This study sought to evaluate the predictive association of clinical pain and psychological variables on ED admission with average daily pain and opioid consumption in subsequently hospitalized patients with cancer. Methods: A prospective cohort study of patients with active cancer presenting to the ED with pain severity ≥4/10 on presentation completed baseline surveys that assessed demographic, socioeconomic, cancer diagnosis and treatment, medication use, and psychosocial profiles using validated questionnaires. Daily pain scores and opioids administrated were abstracted from the hospital record. Univariable and multivariable general estimating equation (GEE) analyses examined associations of baseline socioeconomic and clinical variables with the primary outcomes, average daily pain and total daily opioid administration. Results: Patients (N = 113) had various types of cancer, with 91% having a diagnosis of &gt; 1 year, 80% with metastatic solid tumors, 73% reported pain as the primary reason for the ED visit, 43% were taking opioids, and 27% had chronic pain predating their cancer. Average daily pain scores ranged between (3.4 to 5.0 out of 10) and daily MMEs ranged between 0 to 1136 MMEs, yet the majority received lower than 60 MMEs per day. In multivariable models, higher pain catastrophizing (B = 0.1, p= 0.001), more recent surgery (B = -0.2 p= 0.016), outpatient opioid use (B = 1.4, p&lt;0.001), and history of chronic pain (B = 0.8, p= 0.022) before cancer diagnosis were independent predictors of greater average daily pain during hospitalization. Higher pain catastrophizing (B = 1.6, p= 0.049), higher anxiety (B = 3.7, p= 0.030), lower depression (B = -4.9, p= 0.028), metastatic disease (B = 16.2, p= 0.038), and outpatient opioid use (B = 32.8, p&lt;0.001) were independent predictors of greater daily opioid administration during hospitalization. Conclusions: An evaluation of psychological distress and current opioid use may help to identify cancer patients at increased risk for more severe pain and higher analgesic requirements during hospitalization. This identification will facilitate the delivery of more intensive pharmacologic and nonpharmacologic interventions.
Advancing equity in prostate cancer outcomes using community-facing navigation in the cancer continuum of care.
Authors: Kristen Stevens Hobbs, Laura Lee Hall, Thomas Farrington, Angelo Moore, LaSonia Barnett, Nadia Aguilera-Funez, Keith Crawford, Jerry George
Journal: Journal of Clinical Oncology (2022)

120 Background: According to the American Cancer Society, prostate cancer is the second most common cause of cancer death in Black men. Between 2014–2018, the prostate cancer incidence rate among Black men was 73% higher than that in white men. Approximately 6,040 Black men are projected to die of prostate cancer in 2022. Many disparities contribute to prostate cancer mortality in Black men, including missed genitourinary (GU) referral appointments. Research has shown that patient navigation can be an effective, evidence-based intervention to improve health outcomes. Improving completion of GU referrals through navigation may advance equity in continuity of care. Methods: An algorithm was integrated into electronic medical records (EMR) to identify Black men eligible for prostate cancer screening in primary care practices of a health system North Carolina. An assessment was adapted for community-facing navigators using existing literature on patient navigation practices. Navigators were trained on culturally responsive prostate cancer education and a plan-do-study-act quality improvement (QI) model. A notice to navigate alert was implemented into the navigation workflow to alert staff of Black men with prostate-specific antigen (PSA) levels of 10 or greater. Results: At baseline, perceived barriers to entering the continuum of care were related to the social determinants of health, as noted by navigators. During the intervention, navigators were alerted of 25 Black men 49 – 74 years of age with PSA levels of 10 and above. Initial PSA results ranged from 10.55 to 101.61 (ng/ml). Twenty-three of them agreed to accept navigation services and were scheduled appointments to follow up with GU. Of the completed appointments, 15 were diagnosed with prostate cancer. Post-intervention, navigators noted barriers to completing GU appointments included health literacy/education, work schedules, transportation, lack of responsiveness to female navigators, the digital divide, social support, and denial of prognosis. Conclusions: Providing Black men with navigation services allowed common barriers to be eliminated, increased GU appointment completion, identified men with prostate cancer at earlier stages, and assisted with earlier initiation of treatment by conducting a warm handoff to clinical navigators. Future studies may seek to understand implementation of the EMR algorithm across all primary care practices, integrating the use of navigators as an intervention, and supplementing culturally—tailored patient education materials to include a digital component.
Sociodemographic and occupational factors associated with receipt of work accommodations among employed breast cancer survivors.
Authors: Jasmin Hundal, Alicia Dugan, Swede Helen
Journal: Journal of Clinical Oncology (2022)

231 Background: Many cancer survivors face occupational challenges when staying in or returning to work after treatment yet little is known about sociodemographic and work-related factors associated with receipt of work accommodations (e.g. flexible work time, reduced workload). Methods: We analyzed data from the PinkWorks study (n = 154 female breast cancer survivors), a cross-sectional online survey. Participants were: ≥18+ years, speak English, ended treatment within 36 months, and working ≥20 hours per week at both the time of diagnosis and currently. Due to small n’s in strata, we performed descriptive analyses (frequencies, Chi-Square tests) to identify possible univariate associations between occupational factors and granting of work accommodations. An exploratory multiple Logistic Regression was performed with receipt of accommodations (yes, no) as the dependent variable. Results: Among participants, 43.8% received work accommodations from employers, and 11% reported that their physicians had a direct conversation with their employer. Participants who were native English speakers were more likely to receive work accommodations compared to those where English is a second language (44.8%, 22.2%, respectively, n.s.). Workers who held executive positions were more likely to receive accommodations compared to those in either supervisory or non-supervisory roles (60.0%, 43.1%, 42.9%, respectively, n.s.). We observed a higher prevalence of work accommodations among participants who reported that a discussion between the physician and employer occurred compared to those who did not report such a conversation (58%, 41.9%, respectively, n.s.) An exploratory logistic regression controlling for age and educational attainment was consistent with descriptive findings regarding language and type of position. Conclusions: Less than half of employed breast cancer survivors were provided work accommodations. Suggestive disparities in the receipt of accommodations were observed among those who were not native English speakers or in non-executive positions. The occurrence of a conversation between the participant’s physician and employer was linked to a higher prevalence of accommodations but the cross-sectional design of the study limits interpretation. Additional multivariate analyses are recommended to further explore these relationships, including structural equation modeling to address the strong interconnections among the study variables.
Grading our quality: An academic and community cancer center dashboard.
Authors: Melis Celmen, Aya Sato-DiLorenzo, Rosemary Chude-Sokei, Irving D. Kaplan, Michael S. Kent, Sheila Malacaria, Andrea Vatulas, Jessica Ann Zerillo
Journal: Journal of Clinical Oncology (2022)

303 Background: Quality scorecards provide a high-level view of key performance metrics and guide data-driven decision making. Dashboards specific to cancer care have not been widely published. Our goal was to implement a quality dashboard to guide and monitor local improvement efforts at an academic and community cancer center. Methods: With the leadership of a Project Manager and Nursing and Physician Quality Directors of the Cancer Center, and input of key Cancer Center stakeholders, quality metrics across national organizations were evaluated. Metrics were chosen based on their ease of collection and their mapping to institutional priorities of clinical quality, patient safety, access, and financial stability. Additional internal measures and benchmarks were created to capture local improvement efforts. Numerous internal and third-party databases were accessed to extract, analyze and display our data. Additionally, a data dictionary was developed for the measure set. Results: Six months of data from fiscal year 2022 was collected, analyzed, and displayed on 10 core and 3 disease-specific measures for breast (B) and lung (L) cancers. (Breast and lung). As of 5/2022, the measures presented on the dashboard include new patient access, non-template chemotherapy orders, medication harm events, likelihood of recommending practice, preventable admissions and emergency department visits, inpatient mortality, and length of stay, readmission, survivorship care plan (B), return to operating room (L), and adequate lymph node sampling (L). These measures pertain to several of the Institute of Medicine’s domains of healthcare quality: effective, efficient, patient-centered, safe, and timely. Conclusions: Compiling data from multiple sources into a single dashboard may guide Cancer Center leadership in strategic planning and monitoring improvement for ongoing initiatives. The data will be updated quarterly. Future iterations will include more disease specific measures and attempts to build automatic data extraction.
International comparison of the impact of COVID on adherence with supportive care focused Choosing Wisely recommendations (CWR).
Authors: Huaqi Li, Melanie Lynn Powis, Erick Figueiredo Saldanha, Rachel Simoes Riechelmann, Abed Baiad, Felicia Peterson Cavalher, Kevin Chen, Maria Rita Silva Costa, Saidah Hack, Zuhal Mohmand, Peter Nakhla, Maria Fernanda Evangelista Simões, Monika K. Krzyzanowska
Journal: Journal of Clinical Oncology (2022)

28 Background: The reorganization of cancer care delivery during the COVID pandemic had the potential to catalyze improvement in CWR adherence by reducing provision of low value care to minimize in-person visits and mitigate potential issues with staff and resource shortages. We evaluated the impact of COVID on adherence with CWR for supportive care, relevant to colorectal and anal cancer patients with stage IV disease at Princess Margaret Cancer Centre (PM) in Canada and AC Camargo Cancer Center (AC) in Brazil. Methods: Eligible patients had a new patient consult 02/2020- 12/2020 (COVID) or the same period in 2019 (control). Performance on individual CWR in the 6 months following initial consultation was calculated as the proportion of eligible patients meeting the recommendation. Results: The PM and AC cohorts each consisted of 100 patients; demographic and disease characteristics of COVID and control cohorts were similar within each centre. Marginally fewer patients received surgery during COVID (PM: 38.3 vs 49.1%, p = 0.28; AC: 54.8 vs 55.2%, p = 0.97). At PM, more patients received radiation therapy during COVID (36.2 vs 24.5%, p = 0.21), whereas the opposite occurred at AC (7.1 vs 17.2%, p = 0.14). A higher proportion of both PM and AC patients treated during COVID died within 6 months of initial consult than in 2019 (PM: 10.6 vs 7.5%, p = 0.015; AC: 21.4 vs 8.6%, p = 0.029). Adherence to selected CWR is summarized below; whereby a higher proportion means higher concordance with CWR. Conclusions: There was low overall adherence to CWR across both centers with no significant changes to patterns of care for patients with stage IV disease during the COVID-19 pandemic.[Table: see text]
ONE Liver: A unique, multidisciplinary virtual tool for prospective review of complex liver tumors.
Authors: Casey Chollet-Lipscomb, Patrick Wolf, Matthew R Bernhard, Kelsey Maduell, Stacey Davidson, Larry Edward Bilbrey, Stephen Matthew Schleicher
Journal: Journal of Clinical Oncology (2022)

59 Background: Primary and secondary malignancies involving the liver represent some of the most complex cases we see in oncology. These tumors often require multi-disciplinary decision making to determine the optimal treatment. For example, the treatment plan for hepatocellular carcinoma or colorectal cancer metastatic to the liver can often include one of several liver-directed therapy options for cure and/or palliation. Obtaining multiple opinions in an expedited and patient-centered way can be challenging for community oncologists, especially those serving a rural community. We opted to create a virtual tumor board with geographical reach across Tennessee for timely comprehensive evaluation of these patients at Tennessee Oncology (TO), a community oncology network spanning over 30 clinical sites of care. Methods: In January 2021, we created a multidisciplinary team containing specialists in medical oncology, radiation oncology, hepatology, radiology, interventional radiology, and hepatobiliary surgery. Medical oncologists at any TO clinic in Tennessee or Georgia could make referrals to the program within the Electronic Health Record (EHR). The team reviewed all submitted cases bi-weekly either virtually or at a centralized location. Referring providers were not required to attend the tumor boards to expand geographical reach. Recommendations were communicated back to the referring physician by both email and letters scanned into the EHR. Results: Between January 1, 2021 and May 1, 2022, a total of 154 referrals representing 126 unique patients were placed to the ONE Liver tumor board. Thirty-three physicians referred patients across 21 practice locations across the state. The top 3 diagnoses were: metastatic colorectal cancer (53), hepatocellular carcinoma (33), and primary biliary cancers (32). The most common first line recommendations were for therapy with Y-90 embolization, further imaging workup, continued systemic therapy and/or clinical trial evaluation, and stereotactic body radiation therapy. All patients were evaluated within 2 weeks of referral with most evaluated in less than 1 week. 60% of patients evaluated lived more than 25 miles from a tertiary medical center and 28% lived more than 50 miles out. Conclusions: This initiative successfully facilitated efficient and multi-disciplinary evaluation of patients with complex liver tumors living in rural areas. Tumor boards of this type might scale disease expertise across larger geographical locations than traditional in-person tumor boards.
Real-world variability in use of bone-modifying drugs for multiple myeloma by payer type.
Authors: SOPHIA Monica Monica Soni, Andrew Allan Hertler
Journal: Journal of Clinical Oncology (2022)

129 Background: The use of bone-modifying agents (BMAs) in multiple myeloma is gold standard. Benefits include prevention of skeletal-related events, reduction in bone pain, and improved progression-free survival. Guidelines recommend that patients with active multiple myeloma receive a BMA for up to two years. Unfortunately, real-world data has shown undertreatment with delays in initiation, interruptions in dosing, and premature discontinuation. These gaps are more pronounced for Black patients. The objective of this study was to describe real-world BMA treatment patterns across different payer types: Medicaid, Medicare, and Commercial/Exchange. Methods: This was a retrospective observational study using oncology prior authorization data from multiple payers in the New Century Health (NCH) database. NCH is specialty risk management company who supported over 107,000 oncology patients in 2021. All patients with a diagnosis of multiple myeloma, as indicated by the treating provider’s office, were included who had a prior authorization request for anti-cancer therapy between January 1, 2021, and December 31, 2021. Use of BMA was defined as having ≥1 authorization request for zoledronic acid or denosumab any time in the prior 24 months. BMA use was also evaluated by payer: Medicaid, Medicare, or Commercial/Exchange. Results: A total of 4774 patients were identified as having active multiple myeloma from January 1, 2021, to December 31, 2021. Fifty-nine percent (59.6%) of patients had at least one authorization request for a BMA submitted by their treating provider any time in the preceding 24 months. While most of the identified patients had Medicare, when request for BMA was disaggregated by payer, meaningful differences were found. For patients with commercial or exchange coverage, 64.6% (281/435) had a BMA requested; for patients with Medicare coverage, 60.1% (2339/3890) had a BMA requested. However, for patients with Medicaid, only 51% (229/449) had a BMA requested. Conclusions: Like other studies, our findings highlight underuse of BMAs in multiple myeloma. Differences in request for BMA across payer types suggests variability in adherence to guidelines may be based on patient insurance. To achieve equitable outcomes, including for patients of lower socioeconomic status, targeted efforts must be put in place to ensure receipt of guideline-directed therapy. A strength of this study is the large population and diversity of patients from practices in 41 states with multiple payer types. However, our analysis is limited by several unknown factors such as patient contraindication to or declination of BMA in past that are not captured in the NCH database. This retrospective study, using a large real-world oncology database, highlights that many patients with multiple myeloma may not be receiving guideline-based BMA therapy and that there are meaningful differences depending on patient insurance type.
Impact of acute toxicities associated with chimeric antigen receptor (CAR) T-cell therapy on health-related quality of life (HRQOL) in relapsed or refractory (R/R) large B-cell lymphoma (LBCL).
Authors: Donald Patrick, Shauna McManus, Lauren Podger, Ashley Saunders, Julia Braverman, Fei Fei Liu, Scott J. Keating
Journal: Journal of Clinical Oncology (2022)

294 Background: TRANSCEND NHL 001 (TRANSCEND; NCT02631044) evaluated efficacy and safety of the CAR T cell therapy lisocabtagene maraleucel (liso-cel) as third-line or later treatment in patients with R/R LBCL. Prior research demonstrated improvements in HRQOL with liso-cel; however, evidence of HRQOL in the context of CAR T cell‒specific adverse events was not evaluated. In TRANSCEND, the incidence of all-grade cytokine release syndrome (CRS) and neurological events (NE) was 42% and 30%, respectively. This analysis examined longitudinal HRQOL in the presence of CRS and NEs among clinical responders. Methods: Patients in TRANSCEND who responded to liso-cel treatment (n = 137) were stratified into 3 groups: no CRS or NEs, either CRS or NEs but not both, and both CRS and NEs. HRQOL was evaluated with the European Organisation for Research and Treatment of Cancer core quality of life questionnaire (QLQ-C30) and EQ-5D-5L. Summary statistics and change from baseline (liso-cel infusion; CFBL) were calculated for each time point. Results: For liso-cel‒treated patients who responded to treatment and developed CRS, NEs, or both, clinically relevant QLQ-C30 functional (physical, role, and cognitive) and fatigue scores indicated a noticeable nadir (low point) around 1 month post-baseline after liso-cel infusion, followed by a trend toward restoration of baseline status, generally achieved by 2 months after baseline. The primary difference between CRS/NE subgroups appeared to be the extent of decline or depth of the nadir. Patients with no CRS or NEs after liso-cel infusion did not experience an initial decrease in HRQOL/increase in symptom severity and instead showed a trend toward improvement over time (Table; QLQ-C30 fatigue as an illustrative example). This was also observed for EQ-5D-5L index scores. Conclusions: These findings support the anecdotal clinical experience that CRS/NEs are not associated with any long-term detriment in overall HRQOL and indicate a need for discussion with patients before treatment and early symptom monitoring and management of CRS or NEs. Clinical trial information: NCT02631044. [Table: see text]